Fs-2400-16 Timber Purchaser's Request For Work

Timber Purchaser's Request for Work
(Act of April 24, 1950, 62 Stat. 83)
Contract Number

FS-2400-0016 (REV.05/2014)
OMB 0596-0225 Exp 5/31/2014

To
Forest Supervisor

Date of Contract

National Forest

Address

/ /
Under the terms of the timber sale contract referred to above, the Purchaser hereby elects to have the Forest Service perform
the work described below. If this request is approved by the Forest Service, the Purchaser agrees to make
advance deposits of $
per
(unit of volume or payment unit) in
accordance with Section*
of the above-designated contract, to cover the estimated
cost,
based on actual cost experience in such work. These deposits may be combined for similar cooperative work and no further
accounting or refund will be made unless provided otherwise below.
The rate shown above, which includes necessary overhead charges, may be adjusted from time to time by 10 days advance
written notice to the Purchaser by the Forest Service.
It is understood that either the Forest Service or the Purchaser may cancel this arrangement by 10 days advance written
notice to the other party at the end of any calendar year or following adjustment of the rates. If the work is not complete at
cancellation, it will be completed by the purchaser. A Forest Service appraisal will compare the value of the work done with
the deposits made for that purpose and if due,
a refund will
be made.
Description
of Work
to be Performed**

Date (mm/dd/yyyy)
/ /

Signature

Title

Acceptance for the Forest Service
While this arrangement is in effect, The Forest Service agrees to perform the work described above for the purchaser
Date (mm/dd/yyyy)
/ /

Signature

Title
Burden Statement

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of
information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0225. The time
required to complete this information collection is estimated to average 1 hour per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender,
religion, age, disability, political beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Persons with
disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA's
TARGET Center at 202-720-2600 (voice and TDD).
To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call
(800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.
* Insert applicable section number
** Refer to contract clauses and specifications
File Code: 2450

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